How to manage hiatus hernia?

Answered by: Prof Suneet Sood | Consultant Surgeon, Malaysia

Q:I have been having pain in my abdomen for more than 1 year. This pain started after I took some painkillers regularly under a doctors supervision. The pain is mainly in the upper right side, just under the ribs. In the beginning the pain was less frequent and used to be only after fatty/oily/spicy food but now it occurs daily almost after every meal no matter what I eat. Along with the pain I start feeling weak and get nausea & dizziness.
I have had all tests done including blood tests, CT scan, ultrasound, barium meal follow through, colonoscopy and endoscopy. The first endoscopy was done about 1 year back and it was normal. Three months back another endoscopy was done and it was found that I have a large hiatus hernia. Since then I've been taking Espra 40 (esomeprazole magnesium) twice a day. Since I've started taking this medicine, the problem of nausea has reduced but the pain and the associated conditions remain. Taking small meals gives me some relief temporarily as does lying on a bed with my head down. While lying down, I feel some pulses at the place of pain and under the navel. By applying pressure on my stomach I am able to feel that the particular vein moves perfectly in the centre of my abdomen. When this happens I'm relieved. Sometimes there is a similar pain on the left side of the abdomen and when I lie down I feel that the particular vein is in the left side towards the area of pain. Even while sitting I get some pain which is relieved on pressing the area. The pain is also felt on the back opposite the area of pain. Is there a possibility of some vein damage or something related?

A:Your symptoms are consistent with a diagnosis of a hiatus hernia. The hiatus is opening in the diaphragm (the membrane in the body that separates the abdominal organs from the heart and lungs). The foodpipe (oesophagus) passes from the chest through this opening and joins the stomach in the abdomen. If the stomach slips (herniates) through this opening the condition is called a hiatus hernia. You can have pain, reflux of food into the mouth, difficulty in swallowing, uneasiness. The treatment is by drugs like esomeprazole, and regulation of food intake, as you have been doing. If this does not relieve the symptoms, you should consider surgery. At surgery the hiatus is repaired, and efforts are made to ensure that the food does not reflux. This lessens the pain. The success is about 90%. You may consider laparoscopic repair for hiatus hernia, if you can find a laparoscopist experienced in this procedure.